| NPI | 1205921350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X008373-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00628000) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-10-14 |